Please follow the Enrollment Instructions below to becomee an electronic submitter for Mississippi Medicaid Conduent.

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be signed and returned to the Conduent office prior to initiation of electronic claims submission or inquiry.

1. EDI Provider Enrollment Form

If the link above does not work properly, please download the form from here:
www.ms-medicaid.com


If you have any questions regarding any of the documents in this package, please call the Conduent EDI Technology Support Center at: 1-800-884-3222.

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

EDI Provider and Enrollment Form

Section 1- Select "New Submitter" and "New Retriever"

• If you are a Provider using a Billing Service, select "Billing Agent/Clearinghouse Authorization"

Section 2- Provider Information

• Please enter your Provider or Group name

• Please complete your demographic and contact information

• Please enter your Pay to Provider Number (PIN), Tax ID,  and Email Address

Section 3- Submitter/Trading Partner ID Number

• New applicants may leave this section blank

Section 4- Contact Information

• Please complete your contact information

Section 5- Submission Method

• Select the first box, "Vendor Software"

• If you are a Provider using a Billing Service, Please select "I Plan to use a Billing Agent"

Section 6- Software Vendor Information

• Please enter the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you.

• If you have paid for our billing software please call our support line for our software information.

Section 7- You may Skip this section

Section8- If you are a provider using a Billing Agent, please have your Billing Agent complete this section

Section 9- Leave blank and the default delimiters will be used

Section 10- Please Skip

Section 11- Select 837P for Professional and 837I for Institutional

Section 12- Please Skip

Section 13- Electronic Response and Report Retrieval for Provider

• Please select "Yes" you will be retrieving your reports electronically

• Please mark the following:

  • 997, 835, 824

Section 14- Electronic Response and Report Retrieval for Billing Agent or Clearinghouse Fill out this section if you are using a Billing Service and wish them to receive your reports; if so, do not fill out section 13

• Select "Yes"

• Enter the Billing Agency's name and Trading Partner ID (you will need to get this from them)

• Please mark the following:

  • 997, 835, 824

Section 15 – Please Skip

On Page 1 of the Trading Partner Agreement, Sign and Date the bottom

Please complete the “Submitter” section on the bottom of page 3 of 3.

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:

Mississippi Medicaid Program
Provider Enrollment
P.O. Box 23078
Jackson, Mississippi 39225

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be faxed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center toll-free at 1-800-884-3222.

Testing

Once you have received your Submitter ID and Password from Mediciad, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.